PARK DUVALLE COMMUNITY HEALTH CENTER INC. NPI 1255354361

NPI Information

NPI: 1255354361
Provider Name: PARK DUVALLE COMMUNITY HEALTH CENTER, INC.

Doing Business As: RUSSELL NEIGHBOROOD HEALTH CENTER

Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

Address:
1425 W. BROADWAY
LOUISVILLE, KY
ZIP 40202
Phone: (502) 584-2992
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PARK DUVALLE COMMUNITY HEALTH CENTER, INC. is a federally qualified health center (fqhc) clinic center in Louisville, KY. PARK DUVALLE COMMUNITY HEALTH CENTER, INC. NPI is 1255354361. The provider is registered as an organization entity type.
The provider Is Doing Business As Russell Neighborood Health Center.

The provider's business location address is:

1425 W. BROADWAY
LOUISVILLE, KY
ZIP 40202
Phone: (502) 584-2992
Fax: (502) 584-3715

The provider's authorized official is Swannie Jett .
The authorized official title is Ceo and has the following contact phone number (502) 774-4401.

The CLIA number assigned to this NPI record is 18D1035437 - community clinic with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 7/26/2006 and was last updated on 11/2/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)	700005	KENTUCKY	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	31000011	MEDICAID	KENTUCKY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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